Abstract

INTRODUCTION

Worldwide, traffic accidents are one of the largest public health problems. They affect all age groups and affect the productivity of the population, with huge economic, social and emotional repercussions. ¹⁵15 . World Health Organization . Global status report on road safety 2013: supporting a decade of action . Luxembourg : WHO ; 2013 . ,^a a Instituto de Pesquisa Econômica Aplicada; Departamento Nacional de Trânsito. Impactos sociais e econômicos dos acidentes de trânsito nas rodovias brasileiras: relatório executivo. Brasília (DF): IPEA; DENATRAN; 2006.rodovias brasileiras: relatório executivo. Brasília (DF): IPEA; DENATRAN; 2006.

According to the World Health Organization, in 2010, traffic accidents accounted for more than 1.2 million deaths and injured between 20 and 50 million individuals. ¹⁵15 . World Health Organization . Global status report on road safety 2013: supporting a decade of action . Luxembourg : WHO ; 2013 . Traffic accidents are the 11 ^th highest cause of death and the 9 ^th highest cause of permanent injury in the general population, and the biggest cause of death in the population aged five to 44 years old. This trend is worrying, as it is estimated that it by 2030 it will have become the 5 ^th largest cause of mortality. ¹⁵15 . World Health Organization . Global status report on road safety 2013: supporting a decade of action . Luxembourg : WHO ; 2013 . The most vulnerable groups are pedestrians, cyclists and motorcyclists, and more than 90.0% of deaths from traffic accidents occur in countries with low to medium indices of development, totaling 48.0% of the world’s vehicles and 2/3 of its population. ⁹9 . Nantulya VM , Reich MR . The neglected epidemic: road traffic injuries in developing countries . BMJ . 2002 ; 324 ( 7346 ): 1139 - 41 .

The rate of traffic accidents in Brazil is among the highest in the world.15,a In the first decade of the 21 ^st century, the country experienced a period of economic development, with a stabilized economy, greater availability of credit and increases in per capita income, which led to a huge increase in the number of motor vehicles, ^b b Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Análise de Situação em Saúde. Mortalidade por acidentes de transporte terrestre no Brasil. Brasília (DF); 2007. (Série G. Estatística e Informação em Saúde).,^c c Instituto de Pesquisa Econômica Aplicada. Mobilidade urbana e posse de veículos: análise da PNAD 2009. Brasília (DF); 2010. (Comunicados do IPEA, 73). especially motorcycles. ^d d Associação Brasileira dos Fabricantes de Motocicletas, Ciclomotores, Motonetas, Bicicletas e Similares. Dados do setor de motocicletas no ano de 2010. São Paulo; 2011 [cited 2011 Oct 2]. Available from: http://abraciclo.com.br

Increasing mobility in both urban and rural areas, linked to the low coverage and poor quality of public transport, made the motorcycle the most flexible means of transport. Moreover, compared to the car it costs less to buy and to run and is increasingly used in work-related activities. ¹1 . Andrade SM , Mello Jorge MHP . Características das vítimas por acidente de transporte terrestre em municípios da Região Sul do Brasil . Rev Saude Publica . 2000 : 34 ( 2 ): 149 - 56 .^,44 . Koizumi MS . Padrão das lesões nas vítimas de acidentes de motocicleta . Rev Saude Publica . 1992 ; 26 ( 5 ): 306 - 15 .^,55 . Martins ET , Linhares MN , Sousa DS , Schroeder HK , Meinerz J , Rigo LA , et al . Mortality in severe traumatic brain injury: a multivariated analysis of 748 Brazilian patients from Florianópolis City . J Trauma . 2009 ; 67 ( 1 ): 85 - 90 .^,77 . Mello Jorge MHP , Koizumi MS . Acidentes de trânsito no Brasil: um atlas de sua distribuição . São Paulo : ABRAMET ; 2007 .^,1111 . Scalassara MB , Souza RKT , Tanno RK , Soares DFPP . Características da mortalidade por acidentes de trânsito em localidade da Região Sul do Brasil . Rev Saude Publica . 1998 ; 32 ( 2 ): 125 - 32 .

12 . Silva PHNV , Lima MLC , Moreira RS , Souza WV , Cabral APS . Estudo espacial da mortalidade por acidentes de motocicleta em Pernambuco . Rev Saude Publica . 2011 ; 45 ( 2 ): 409 - 15 .

13 . Souza MFM , Malta DC , Conceição GMS , Silva MMA , Gazal-Carvalho C , Morais Neto OL . Análise descritiva e de tendência de acidentes de transporte terrestre para políticas sociais no Brasil . Epidemiol Serv Saude . 2007 ; 16 ( 1 ): 33 - 44 .^-1414 . Veronese AM , Oliveira DLLC . Os riscos dos acidentes de trânsito na perspectiva dos moto-boys : subsídios para a promoção da saúde . Cad Saude Publica . 2006 : 22 ( 12 ): 2717 - 21 .

The number of motorcycles in Brazil rocketed from approximately 2,800,000 in 1998 to 16,500,000 in 2010, an increase of 490.0%, which meant motorcycles jumped from 11.5% of all motor vehicles in Brazil to 26.1%. The overall number of vehicles increased by 160.0% in the same period, from approximately 25,000,000 to 63,000,000. ^d d Associação Brasileira dos Fabricantes de Motocicletas, Ciclomotores, Motonetas, Bicicletas e Similares. Dados do setor de motocicletas no ano de 2010. São Paulo; 2011 [cited 2011 Oct 2]. Available from: http://abraciclo.com.br

Despite the epidemiological relevance of the problem and the availability of data from official sources, there are no studies that analyze the evolution of deaths from motorcycle accidents in Brazil.

The aim of this study was to analyze motorcycle accident mortality trends in Brazil.

METHODS

This is a descriptive time series study of mortality from motorcycle accidents in Brazil according to state and age group between 1996 and 2009. From 1996 onwards the Sistema de Informação sobre Mortalidade ^e e Ministério da Saúde. DATASUS. Informações de Saúde [base de dados na Internet]. Brasília (DF): 2009 [cited 2010 Jun 17]. Available from: http://www2.datasus.gov.br/DATASUS/index.php (SIM – National Mortality Information System) began to record deaths according to the tenth revision of the International Classification of Diseases (ICD-10). In this study, it was decided to use 1996 as the initial period of analysis, due to the aforementioned change in recording data.

Data on mortality were obtained from the SIM. Deaths from traffic accidents were considered to be those of a driver or passenger (ICD-10 codes V200–V29). Population data were gathered from the Brazilian Institute of Geography and Statistics (IBGE). ^f f Instituto Brasileiro de Geografia e Estatística. População estimada por idade: revisão 2009. Rio de Janeiro; 2009.

In order to perform appropriate analysis and comparison between states and years, the total mortality rates for accidents involving motorcycles per 100,000 inhabitants were standardized using the direct method, considering the year 2000 as a benchmark for the population of Brazil. The unstandardized mortality rates were assessed according to age group: zero to 19 years old (children and adolescents), 20 to 59 years old (adults) and ≥ 60 (the elderly).

A database was constructed using the Stata 9.0 software, in which the analyses were undertaken. Prais-Winsten ³3 . Gaynor PE , Kirkpatrick RC . Introduction to time series modeling and forecasting in business and economics . New York : McGraw-Hill ; 1994 . linear regression models were used to quantify annual variations in the mortality rates with the respective 95% confidence intervals allowing trend analysis from 1996 to 2009. The rates were deemed to be stable when the coefficient of regression was not significantly different from zero (p > 0.05), to be increasing when the coefficient was positive and decreasing when it was negative.

RESULTS

The mortality rate from motorcycle accidents in Brazil increased by 800.0%, going from 0.5 to 4.5/100,000 inhabitants between 1996 and 2009, a mean increment of 19.0% per year.

Piauí (12.2/100,000 inhabitants) and Sergipe (11.4/100,000 inhabitants), in the Northeast, had the highest mortality rates in 2009, with a mean annual increase of over 30.0%. The state of Bahia had one of the lowest mortality rates (2.3) although it had one of the highest annual growth rates (27.4%). In the North, the mortality rates for Tocantins (10.8) and Rondônia (7.1) per 100,000 inhabitants stood out. Roraima was the only state in which there was a decrease (-6.4%) in the mortality rate, although the rate remained high (6.8). The rates for Mato Grosso (11.7) and Mato Grosso do Sul (8.4) stood out in the Midwest region. Espírito Santo had the highest mortality rate (7.2) and the highest annual growth rate (29.8%) in the Southeast, with Sao Paulo (3.3), Minas Gerais (3.2) and Rio de Janeiro (2.5) showing the lowest rates (Tables 1 and 2, Figure 1).

In the South, Santa Catarina had high mortality rates (8.5), despite a low growth rate (10.5%) compared to those observed in the states in the Northeast. On the other hand, it had one of the highest mortality rates (4.5) for the zero to 19 year old age group (Tables 1 and 2 and Figures 1 and 2). The state of Rio Grande do Sul (3.0) had the lowest rate in the South.

Amazonas (2.8), Amapá (1.8), Acre (0.8) and Rio de Janeiro (2.5) had the lowest mortality rates. Sergipe (19.1), Mato Grosso (19.1), Piauí (18.8), Tocantins (17.1) and Mato Grosso do Sul (13.4) stood out for mortality among adults and the elderly (Figures 2 and 3).

DISCUSSION

In Brazil, there was a significant increase in mortality from motorcycle accidents between 1996 and 2009. This period was characterized by millions of individuals moving out of poverty and moving upwards socially and economically, acquiring their first vehicle, often a motorcycle. This situation was more conspicuous in the North, Northeast and Midwest regions. ⁹9 . Nantulya VM , Reich MR . The neglected epidemic: road traffic injuries in developing countries . BMJ . 2002 ; 324 ( 7346 ): 1139 - 41 .^,1515 . World Health Organization . Global status report on road safety 2013: supporting a decade of action . Luxembourg : WHO ; 2013 .,^a a Instituto de Pesquisa Econômica Aplicada; Departamento Nacional de Trânsito. Impactos sociais e econômicos dos acidentes de trânsito nas rodovias brasileiras: relatório executivo. Brasília (DF): IPEA; DENATRAN; 2006.rodovias brasileiras: relatório executivo. Brasília (DF): IPEA; DENATRAN; 2006.,^b b Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Análise de Situação em Saúde. Mortalidade por acidentes de transporte terrestre no Brasil. Brasília (DF); 2007. (Série G. Estatística e Informação em Saúde).,^c c Instituto de Pesquisa Econômica Aplicada. Mobilidade urbana e posse de veículos: análise da PNAD 2009. Brasília (DF); 2010. (Comunicados do IPEA, 73).

The increase in the number of motor vehicles is a worldwide phenomenon, as is the increase in the number of motorcycles.a Mortality rates from motorcycle accidents have increased worldwide, especially in low and middle income countries. ⁹9 . Nantulya VM , Reich MR . The neglected epidemic: road traffic injuries in developing countries . BMJ . 2002 ; 324 ( 7346 ): 1139 - 41 .^,1515 . World Health Organization . Global status report on road safety 2013: supporting a decade of action . Luxembourg : WHO ; 2013 . Even in high-income countries such as the United States, the mortality rates increased 55.0% between 2001 and 2008, from 1.12 to 1.74/100,000 inhabitants. ²2 . Beck LF , Dellinger AM , O`Neil ME . Motor vehicle crash injury by mode of travel, United States: using exposure- based methods to quantify differences . Am J Epidemiol . 2007 ; 166 ( 2 ): 212 - 18 .^,1010 . Paulozzi LJ , Ryan GW , Espitia-Hardeman VE , Xi Y . Economic development´s effect on road transport-related mortality among different road users: a cross sectional international study . Accid Anal Prev . 2007 ; 39 ( 3 ): 606 - 17 .,^g g National Research Council, National Highway Traffic Safety Administration. Countermeasures that work: a highway safety countermeasures guide for state highway safety offices. 5.ed. Washington (DC): NHTSA; 2010.

Ownership of vehicles and motorcycles differs between the states, varying from up to 70.0% of households, as in Santa Catarina, to 26.0%, in Alagoas. ^c c Instituto de Pesquisa Econômica Aplicada. Mobilidade urbana e posse de veículos: análise da PNAD 2009. Brasília (DF); 2010. (Comunicados do IPEA, 73). States that have larger public transport systems – such as Sao Paulo, Rio de Janeiro, Minas Gerais and Rio Grande do Sul, where a significant number of the population use public transport such as buses, trains and metro – have lower mortality rates.

This study showed the growing public health problem of motorcycle accidents and death resulting from motorcycle accidents. With the rapid expansion in the number of motorcycles came a significant increase in the mortality rates in all regions and states, especially in the North, Northeast and Midwest of the country. This increase accompanied the growing number of vehicles and the increasing proportion of the population who moved out of poverty, although this study does not allow for inferences on causal relationships. ^c c Instituto de Pesquisa Econômica Aplicada. Mobilidade urbana e posse de veículos: análise da PNAD 2009. Brasília (DF); 2010. (Comunicados do IPEA, 73).

The growth in mortality rates in the North, Northeast and Midwest may be related to economic development, which stems from the appearance of new agricultural frontiers and agri-business in Maranhão, Tocantins, Piauí and Bahia. In addition, it could be due to the development of economic activities connected to petroleum and mining in Espírito Santo and Sergipe. Over the last decade, there has been an important cycle of economic development and improvements in income distribution in Brazil, which provided access to consumer goods for a considerable part of the population. The number of motorcycle accident victims overtook the number of car accident victims in 2007, and the number of pedestrian victims in 2009, a trend that is likely to continue in coming years. The motorcycle is one of the most dangerous means of transport. Means of prevention in which the authorities are the main protagonist need to be intensified. ²2 . Beck LF , Dellinger AM , O`Neil ME . Motor vehicle crash injury by mode of travel, United States: using exposure- based methods to quantify differences . Am J Epidemiol . 2007 ; 166 ( 2 ): 212 - 18 .^{, 10}10 . Paulozzi LJ , Ryan GW , Espitia-Hardeman VE , Xi Y . Economic development´s effect on road transport-related mortality among different road users: a cross sectional international study . Accid Anal Prev . 2007 ; 39 ( 3 ): 606 - 17 .,^g g National Research Council, National Highway Traffic Safety Administration. Countermeasures that work: a highway safety countermeasures guide for state highway safety offices. 5.ed. Washington (DC): NHTSA; 2010.

The deficient road infrastructure, the difficulty of monitoring driving licenses, use of protective equipment such as helmets, drinking and driving and the lack of medical attention in these regions contribute to the high mortality rates and need to be faced up to by the public. There was a fall in the rates in the Southeast after 2008, which could be due to more rigorous enforcement of the Lei Seca (Dry Law) there than in other regions. ⁶6 . Malta DC , Soares Filho AM , Montenegro MMS , Mascarenhas MDM , Silva MMA , Lima CMM , et al . Análise da mortalidade por acidentes de transporte terrestre antes e após a Lei Seca - Brasil, 2007-2009 . Epidemiol Serv Saude . 2010 ; 19 ( 4 ): 317 - 28 .,^h h Brasil. Lei nº 11.705. de 19 de junho de 2008. Altera a Lei nº 9.503, de 23 de setembro de 1997, que ‘institui o Código de Trânsito Brasileiro’, e a Lei nº 9.294, de 15 de julho de 1996, que dispõe sobre as restrições ao uso e à propaganda de produtos fumígeros, bebidas alcoólicas, medicamentos, terapias e defensivos agrícolas, nos termos do § 4º do art. 220 da Constituição Federal, para inibir o consumo de bebida alcoólica por condutor de veículo automotor, e dá outras providências. Brasília (DF); 2008 [cited 2013 Oct 30]. Available from: http://www.planalto.gov.br/ccivil_03/_ato2007-2010/2008/lei/l11705.htm

The variation in the quality of SIM records may have influenced the results observed. Data are better recorded in the South and Southeast of the country and there was a substantial decrease in the quantity of deaths classified as from unknown causes during the period. ⁸8 . Mello Jorge MHP , Laurenti R , Gotlieb SLD . Análise da qualidade das estatísticas vitais brasileiras: a experiência de implantação do SIM e do SINASC . Cienc Saude Coletiva . 2007 ; 12 ( 3 ): 643 - 54 . It is expected that, with the quality of information improving over the years, there would be increases in deaths classified under different ICD-10 codes, including motorcycle accidents, which could mean an artificial increase in mortality rates. However, the increase was on such a scale that this reason alone is not enough to explain it.

This study emphasizes the importance of using the increasingly reliable SIM data to monitor mortality rates for external causes in the different regions and states of Brazil, for scientific purposes and for health policies. Continuous and intense use will lead to even better qualification of its records.

This study showed that there has been a huge increase in motorcycle accident mortality rates in Brazil, especially in states in the Northeast. The findings suggest that policy makers may not have satisfactorily taken responsibility for controlling and reducing traffic accidents and mortality from traffic accidents, above all those involving motorcycles. The need to prevent injury and death from motorcycle accidents is a significant and growing public health problem in Brazil.

References

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